Hostilities in the Gaza Strip and Israel | Flash Update #96

Key points 

• Intense Israeli bombardments from air, land, and sea continued across much of the Gaza Strip on 18 January, resulting in further civilian casualties and destruction. The indiscriminate firing of rockets by Palestinian armed groups from Gaza continued. Ground operations and fighting between Israeli forces and Palestinian armed groups were also reported across much of Gaza. On 17 January, the UN Secretary-General repeated his call for an immediate humanitarian ceasefire in Gaza. 
• Between the afternoons of 17 and 18 January, according to the Ministry of Health (MoH) in Gaza, 172 Palestinians were killed, and another 326 people were injured. Between 7 October 2023 and 12:00 on 18 January 2024, at least 24,620 Palestinians were killed in Gaza and 61,830 Palestinians were injured, according to the MoH.  
• Between 17 January and 18 January, no Israeli soldiers were reportedly killed in Gaza. Since the start of the ground operation, 191 soldiers have been killed, and 1,178 soldiers have been injured in Gaza, according to the Israeli military. 
• As of 18 January, telecommunication services in Gaza have remained shut down for the sixth consecutive day, since 12 January. In light of this, new information is limited in this Flash Update. This is the seventh time that communications have stopped working since 7 October. The blackout of telecommunications prevents people in Gaza from accessing lifesaving information or calling for first responders and impedes other forms of humanitarian response. 
• The availability of water for drinking and domestic use in Gaza is shrinking each day. At present, only one of the three Israeli lines is functional, yielding less than half (22,000 cubic metres a day) of what would have been available if all lines were working (For more information see Water, Sanitation and Hygiene section). 
• On 18 January, the non-governmental organization Medical Aid for Palestinians (MAP) reported that: “This morning, at around 6am, the compound in Gaza housing staff members of the Emergency Medical Team from MAP and the International Rescue Team (IRC) was severely damaged as a result of a missile strike. A number of team members & the compound’s security guard suffered non-life-threatening injuries.” The team had been providing surgery and other medical treatment supporting the overstretched medical staff in Nasser hospital. Following the strike, they have been evacuated and can no longer continue working at the hospital. This reported attack and subsequent move of staff further compromise the already frail capacity in the over-congested hospital. 
• As of 18 January, the MoH in Gaza stated that over 8,000 cases of viral Hepatitis A resulting from overcrowding in shelters had been recorded. The number of hepatitis cases is expected to double in overcrowded shelters. Additionally, due to the lack of access to hospitals, 60,000 pregnant women are at risk of not receiving adequate care in case of complications. Hundreds of cases of miscarriages and premature births have been reported since the outbreak of hostilities.  
• On 18 January, the Israeli military confirmed that it had removed corpses from a graveyard in Khan Younis, as it suspected hostages may have been buried there. This follows reports on 17 January, at about 7:00, when Israeli forces withdrew from the vicinity of Nasser Hospital, in Khan Younis and subsequent reports and video footage show that much of the An Namsawi cemetery was destroyed and graves with corpses missing. 
• On 18 January, UNICEF Deputy Executive Director Ted Chaiban said: “Once aid enters the Gaza Strip, our ability to distribute it becomes a matter of life and death. It is essential to lift access restrictions, ensure reliable ground communications, and facilitate the movement of humanitarian supplies to ensure that those who have been without assistance for several days receive much-needed assistance. We have to get commercial traffic flowing in Gaza, so that markets can reopen, and families are less dependent on relief.” 

Hostilities and casualties (Gaza Strip) 

• The communications shutdown has limited the full reporting of incidents. However, the following are among the deadliest incidents reported on 17 January:  
  • On 17 January, at about 15:30, three Palestinian IDPs, including one child, were reportedly killed when a group was struck west of Rafah. 
  • On 17 January, at about 23:00, 19 Palestinians, including at least eight children and six women, were reportedly killed when a house was struck near the Al Bahabsa Mosque area, in Al Geneina neighbourhood, east of Rafah. 
• On 17 January, Israeli forces detonated explosives and destroyed the Israa University in Madinat Az Zahraa, south Gaza city. Reportedly, for the past 70 days, the building had been used by the Israeli military as a military base and an ad hoc detention facility for interrogating Palestinian detainees before their transfer to an unknown location. 

Displacement (Gaza Strip)

• As of 18 January, according to UNRWA, 1.7 million people were estimated to be internally displaced. Many of them have been displaced multiple times, as families have been forced to move repeatedly in search of safety. The ability of UNRWA to provide humanitarian support and updated data on the number of internally displaced people (IDPs) has been severely restricted. Due to the continued escalation of fighting and evacuation orders, some households have moved away from the shelters where they were initially registered. These resulted in multiple registration of the same IDPs in multiple shelters. UNRWA plans to conduct a more accurate count of IDPs in shelters, including informal shelters as soon as the security situation allows. 
• Rafah governorate is the main refuge for those displaced, with over one million people squeezed into an extremely overcrowded space, following the intensification of hostilities in Khan Younis and Deir al Balah and the Israeli military’s evacuation orders. Obtaining an accurate figure of the total number of IDPs remains challenging. 

Electricity

• Since 11 October 2023, the Gaza Strip has been under an electricity blackout, after the Israeli authorities cut off the electricity supply, and fuel reserves for Gaza’s sole power plant were depleted. The communications and industrial fuel shutdown continue to significantly hinder the aid community’s efforts to assess the full extent of needs in Gaza and to adequately respond to the deepening humanitarian crisis. For more information on electricity supply to the Gaza Strip, please see this dashboard

Health care, including attacks (Gaza Strip)

• According to WHO, only 15 out of Gaza’s 36 hospitals are functional, albeit partially: nine in the south and six in the north. In Deir al Balah and Khan Younis, three hospitals – Al Aqsa, Nasser, and Gaza European – are at risk of closure due to the issuance of evacuation orders in adjacent areas and the ongoing conduct of hostilities nearby. Hospitals in the north have been offering limited maternity, trauma, and emergency care services. However, they face challenges such as a shortage of medical staff, including specialized surgeons, neurosurgeons, and intensive care staff, as well as a lack of medical supplies, and have an urgent need for fuel, food, and drinking water. The nine partially functional hospitals in the south are operating at three times their capacity, while facing critical shortages of basic supplies and fuel. According to the MoH in Gaza, occupancy rates are reaching 206 per cent in inpatient departments and 250 per cent in intensive care units. 

Water, Sanitation and Hygiene 

• The availability of water in Gaza is shrinking each day. According to water, sanitation, and hygiene (WASH) humanitarian partners, water availability through the municipal wells is presently at a tenth (21,200 cubic metres a day) of its production capacity prior to the escalation of hostilities (255,000 cubic metres a day). Water from these wells is known to be substandard given it is brackish (salty) water and whereas water from the Israeli-operated lines yielded the most optimal safe drinking water prior to the hostilities. At present, only one of the three Israeli lines – the Bani Said point – is functional, yielding less than half (22,000 cubic metres a day) of what would have been available if all lines were working.  
• Furthermore, water availability through the short-term desalination plants presently stands at seven per cent (1,600 cubic metres per day) of the pre-crisis capacity (22,000 cubic metres per day). Due to import restrictions on critical items, water testing kits and chlorine to treat the water across Gaza are presently unavailable. Furthermore, the amalgamation of solid waste and fecal waste, exacerbated by rains and floods, is giving rise to severe health and environmental threats. With WHO already reporting 152,000 cases of diarrhoea, the inability to do water chlorination to kill bacteria is aggravating the already concerning situation. At present, Health and WASH partners have developed an Acute Watery Diarrhoea preparedness and response plan. Barriers to the import of critical items must be resolved to enable adequate response. 

Humanitarian Access 

• On 17 January, 98 truckloads with food, medicine and other supplies entered the Gaza Strip through Rafah and Kerem Shalom crossings. Since the opening of Kerem Shalom crossing, almost 22 per cent of aid trucks have come in through that entry point. 
• In the first two weeks of January, humanitarian agencies planned 29 missions to deliver lifesaving supplies to areas to the north of Wadi Gaza. Only 7 of the 29 (24 per cent) were accomplished, either fully or partially. The remainder of the missions were denied access by the Israeli authorities. Two additional missions, originally coordinated with the Israeli authorities, could not be completed due to the non-viability of allocated routes or excessive delays at checkpoints, which did not allow the missions to succeed during the safe operating windows.  
• The denials of humanitarian missions’ access to areas north of Wadi Gaza over the first half of January spiked compared with the previous months; in October and December 2023, only 14 per cent (6 out of 43) of missions planned to the north were denied, while the remaining 86 per cent (37 out of 43 missions) were facilitated. These denials prevent a scale-up in humanitarian assistance and add significant cost to the overall response. Additionally, planned missions that are denied access to areas north of Wadi Gaza represent opportunities missed for alternative missions that could be undertaken to other areas of the Gaza Strip. The capacity of humanitarian agencies to operate safely and effectively also remains heavily compromised by the long-term restrictions applied by the Israeli authorities on the import of critical humanitarian equipment into Gaza. 

Hostilities and casualties (Israel) 

• Over 1,200 Israelis and foreign nationals have been killed in Israel, including 36 children, according to the Israeli authorities, the vast majority on 7 October. 
• As of noon on 15 January, the Israeli authorities estimated that about 136 Israelis and foreign nationals remained captive in Gaza. During the humanitarian pause (24-30 November), 86 Israeli and 24 foreign national hostages were released. 

Violence and casualties (West Bank)

• On 18 January, Israeli forces shot and killed two Palestinian men in two separate incidents during ongoing Israeli military operations in Nur Shams and Tulkarm refugee camps close to Tulkarm city. This brings to eight, including two children, the number of Palestinians killed in both camps over the past two days, and the number of injuries to at least 26. Throughout the operation, reportedly there was an exchange of fire between Israeli forces and Palestinians, throwing of pipe bombs by Palestinians and the use of airstrikes by Israeli forces. In both camps as well as in Tulkarm city, Israeli forces reportedly detonated and demolished at least three Palestinian houses, bulldozed road infrastructure, leading to cut-offs in water and electricity, and in some cases delayed access of ambulances to evacuate the injured and dead. Initial information indicate that dozens of houses sustained minor to moderate damage and at least 300 Palestinians were detained and interrogated. 
• Since 7 October 2023 and as of 18 January 2024, 357 Palestinians have been killed, including 90 children, across the West Bank, including East Jerusalem. Additionally, two Palestinians from the West Bank were killed while carrying out an attack in Israel on 30 November. Of the fatalities in the West Bank (357), 348 were killed by Israeli forces, eight by Israeli settlers and one by either Israeli forces or settlers. So far in 2024 (as of 18 January), 48 Palestinians, including nine children, have been killed. The number of Palestinians killed in the West Bank, including East Jerusalem, in 2023 (507) marks the highest number of Palestinians killed in the West Bank since OCHA started recording casualties in 2005. 
• Since 7 October 2023 and as of 18 January 2024, five Israelis, including four members of Israeli forces, have been killed in Palestinian attacks in the West Bank, including East Jerusalem. In addition, four Israelis were killed in an attack carried out by Palestinians from the West Bank in West Jerusalem (one of the four was killed by Israeli forces who misidentified him) on 30 November 2023. Another Israeli woman was killed in another attack perpetrated by Palestinians in Israel on 15 January 2024. The number of Israelis killed in the West Bank and Israel in 2023 in attacks perpetrated by Palestinians from the West Bank (36) was the highest since OCHA started recording casualties in 2005. 
• Since 7 October 2023 and as of 18 January 2024, 4,252 Palestinians, including 645 children, have been injured in the West Bank, including East Jerusalem. Of them, 4,121 have been injured by Israeli forces, 110 by settlers and 21 by either Israeli forces or settlers. Of the total injuries, 53 per cent were reported in the context of search-and-arrest and other operations, 35 per cent in demonstrations and 8 per cent during settler attacks against Palestinians. Some 33 per cent of those injuries have been caused by live ammunition, compared with 9 per cent in the first nine months of 2023. 

Settler Violence

• Since 7 October 2023 and as of 18 January 2024, OCHA recorded 433 Israeli settler attacks against Palestinians, resulting in Palestinian casualties (42 incidents), damage to Palestinian-owned property (338 incidents), or both casualties and damage to property (53 incidents). This reflects a daily average of four incidents since 7 October 2023 until 17 January 2024. 
• One-third of the settler attacks against Palestinians after 7 October 2023 have involved firearms, including shootings and threats of shootings. In nearly half of all recorded incidents after 7 October, Israeli forces were either accompanying or reported to be supporting the attackers. 
• In 2023, 1,229 incidents involving Israeli settlers in the West Bank, including East Jerusalem (with or without Israeli forces), resulted in Palestinian casualties, property damage or both. Some 913 of these incidents resulted in damage, 163 resulted in casualties and 153 resulted in both. This is the highest number of settler attacks against Palestinians in any given year since OCHA started recording incidents involving settlers in 2006. 

Displacement (West Bank) 

• Since 7 October 2023 and as of 18 January 2024, at least 198 Palestinian households comprising 1,208 people, including 586 children, have been displaced amid settler violence and access restrictions. The displaced households are from at least 15 herding/Bedouin communities. More than half of the displacements occurred on 12, 15, and 28 October, affecting seven communities. The displacement toll since 7 October 2023, represents 78 per cent of all displacement reported due to settler violence and access restrictions since 1 January 2023 (1,539 people, including 756 children).  
• Since 7 October 2023 and as of 18 January 2024, 478 Palestinians, including 239 children, have been displaced, following the demolition of their homes, due to lack of Israeli-issued building permits in Area C and East Jerusalem, which are almost impossible to obtain. 
• A total of 19 homes have been demolished and 95 Palestinians, including 42 children, displaced due to punitive demolitions from 7 October 2023 and as of 18 January 2024. The numbers exceed those reported in the first nine months of the same year, during which 16 homes were punitively demolished and 78 people displaced.  
• Since 7 October 2023 and as of 17 January 2024, 602 Palestinians, including 263 children, have been displaced, following the destruction of 94 homes during other operations carried out by Israeli forces across the West Bank. About 94 per cent of the displacement was reported in the refugee camps of Jenin, and in Nur Shams and Tulkarm, both in Tulkarm. This represents 65 per cent of all displacement reported due to the destruction of homes during Israeli military operations since January 2023 (908 people).  

Funding

• As of 16 January, Member States have disbursed $689.8 million against the updated Flash Appeal launched by the UN and its partners to implement its response plan in support of 2.2 million people in the Gaza Strip and 500,000 people in the West Bank. This constitutes 57 per cent of the $1.2 billion requested. Private donations are collected through the Humanitarian Fund. 

HUMANITARIAN NEEDS AND RESPONSES: 7-14 January

Health 

Needs: 

• According to WHO, only 15 of Gaza’s 36 hospitals are partially functional - nine in the south and six in the north.  
• According to the MoH in Gaza, there is a shortage of available hospital beds, as occupancy rates in these hospitals are reaching 206 per cent in inpatient departments and 250 per cent in intensive care units. 
• Food, drinking water, fuel, medical supplies, and support to health workers through rotations and additional personnel, are urgently needed in healthcare facilities across Gaza.  
• During missions to Shifa, Al Helou, Al Aqsa and Nasser hospitals to deliver supplies, fuel, and conduct assessments on 13 January, the WHO team observed the following: 
• A drastic decrease in the number of health personnel in some of the hospitals.  
• Only 12 medical doctors are still working at the Al Aqsa hospital, which is about 10 per cent of the staff who operated before the start of the hostilities. 
• The maternity unit at Al-Aqsa Hospital is not operating and is referring all pregnant women to Al Awda Hospital, which is further away, putting patients at risks during the additional travel time, due to ongoing hostilities. 
• Poor living conditions in shelters have resulted in a rise in water-borne diseases 

Response: 

• Eleven Emergency Medical Teams (EMTs) are present in Gaza Strip and have been providing support to hospitals across the Strip. 
• Health and WASH partners are finalizing an inter-cluster outbreak preparedness and response plan; and are mapping out formal and informal shelters which are without access to primary healthcare services, to identify partners to cover the gaps. 

Challenges and Gaps: 

• The security situation, access, transport, and deconfliction remain extremely challenging, especially hospitals in the northern governorates.  
• Partners’ operations continue to be adversely affected by the displacement of staff and also telecommunication challenges. 
• There is an urgent need to conduct assessments on the outbreak of communicable diseases, such Hepatitis A, to identify the most affected groups, hotspot locations and other key epidemiological information. This is essential to tailor a proper response plan to address identified cases and prevent the spread of disease. 

WASH 

Needs: 

• Flooding is being reported across different parts of the Gaza Strip due to winter weather, extensive infrastructure damage and destruction and the clogging of sewage systems and wastewater.  
• Rainwater lagoons have been contaminated by wastewater and several lagoons are at risk of flooding if the rainfall intensifies. This poses a serious environmental and public health concern.  
• WHO reported an increase in Hepatitis A cases in the Middle Area and Rafah governorates, with the current water and sanitation conditions proving a high risk for further spread. 
• To manage water supply and waste-management alone, 22 generators have been requested. These items are pending entry into Gaza.  
• Only one of the three water pipelines from Israel is currently functioning. The Middle Area water pipeline, with a production capacity of close to 17,000 cubic metres of water per day, needs repairs. It is estimated that repairs would take up to four weeks, even given sustained access and necessary supplies.  
• Only two of the remaining three main low-capacity water desalination plants in Deir al Balah and southern Gaza are currently operational and are producing up to 2,400 cubic metres each day.  

Response: 

• Despite these challenges, WASH partners have undertaken the following responses since October 2023:  
  • Some 34,000 cubic metres of water have been delivered through water trucking and 2,400 metres through bottled water.  
  • More than 53,000 jerrycans and more than 40 storage tanks have been distributed.  
  • Nearly 145,000 hygiene kits and 1,800 cleaning kits have been distributed. 

Challenges and Gaps:  

• Humanitarian partners have not been able to assess or resupply fuel to the Jabalya area, where sewage flooding was reported in the refugee camp on 5 January. At least 100,000 IDPs are estimated to reside in the UN and public shelters in this area.  
• Markets are not functioning and construction materials for latrines, desludging services and other essential supplies for sanitation are not available for purchase.  
• Import restrictions, as well as complex and unpredictable clearance procedures for critical items considered by Israel as dual use, such as generators, pumps, and pipes are preventing a scale up of the WASH response.  

Protection 

Needs:  

• Hundreds of detainees who have been released and returned to Gaza since December 2023, need support. Some were able to return to families while others moved to shelters. 
• There is a need for safe shelters for women at risk of gender-based violence (GBV).  
• There is still a high demand for women’s hygiene supplies across Gaza.

Response:  

• Protection partners continue to support formerly detained Gazans released through Kerem Shalom Crossing. Partners provide a support package comprised of food, water, clothes, blankets, hygiene supplies as well as medical care and treatment. The long-term needs include advanced mental health and psychosocial support.  
• The GBV Sub cluster is coordinating the distribution of critical hygiene supplies for women and girls to the northern governorates, coordinating with relevant actors for distribution, procurement, and access.  
• The sub cluster will also review the composition of dignity kits based on changing needs and feedback from women.  
• Women Affairs Centre is preparing an assessment on the impact of current hostilities on women and girls, and the sub cluster will prepare for a wider scale assessment, including elements that can be used in any future intersectoral needs assessments.  
• Mine Action partners continue to conduct outreach and risk education in Rafah through in-person sessions.  

Challenges and Gaps:  

• Communication and network outages greatly curtailed the ongoing lifesaving Mine Action work, including